Welcome Back Survey

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1. How are you and your family doing now? REQUIRED Please fill out this field.
2. Did you lose loved ones during the pandemic? REQUIRED Please fill out this field.
If yes, would you share their names so we can pray for them with you? Names: Please enter valid data.
3. Did you use any of our outreach/programs this past year? (Check all that apply.) a. Livestream Masses b. Flock notes c. Facebook posts d. In person Masses with social distancing e. Greeters/ushers at Masses
4. Did you have to postpone or change plans for a sacrament or rite at the parish because of the pandemic? (Check all that apply.) a. Funeral service for a loved one b. Wedding c. Baptism d. Confirmation e. First Communion f. Celebration of a special anniversary such as 50th g. Other
g. Other: Please enter valid data.
If yes, should we contact you to discuss and offer our assistance? Yes No
5. What are your plans for coming back to Mass? REQUIRED Please fill out this field.
f. Other: Please enter valid data.
6. Are you interested in participating in any of these ministries or programs? (Select all that apply) a. Children’s Liturgy of the Word b. Fellowship after Masses c. Parish retreat d. Family Catechesis e. Adult Scripture Study f. Lutheran Care Center outreach g. Prayer Shawl Ministry h. Teen Club
i. Other Please enter valid data.
7. As we plan for a series of “Welcome Back” activities at our Parish, which activities are most appealing to you and your family? a. Welcome Back Mass at St. Stanislaus Kostka b. A Memorial Mass of Remembrance c. Adult social event/reception or parents-night-out d. Children’s activity/fair/carnival/scavenger hunt e. Outdoor movie night or other family activities f. Trivia night g. Special Rosary gatherings/ Adoration/worship opportunities
h. Other Please enter valid data.
8. For the “Welcome Back” activities, would you/your family be interested in attending and/or willing to volunteer to help prepare for this event? REQUIRED Please fill out this field.
Contact information: For our records, can you please provide:
Your Name REQUIRED Please fill out this field. Please enter valid data.
Spouse's Name Please enter valid data.
Child(ren)'s Name(s) & Age(s) Please enter valid data.
Current Mailing Address REQUIRED Please fill out this field. Please enter valid data.
Your Email REQUIRED Please fill out this field. Please enter valid data.
Spouse's Email Please enter valid data.
Best phone number to reach you REQUIRED Please fill out this field. Please enter valid data.
How long have you been in the Parish? REQUIRED Please fill out this field. Please enter valid data.

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St. Stanislaus Kostka Church

Catholic Parish in Pleasant Valley, NY

Welcome Back Survey

St. Stanislaus Kostka Welcome Back Survey